Segment
X12 EDI Release 00303
To specify the claim service detail for anesthesia
Elements
  • SV601235Product/Service ID Qualifier
    ID
    M必须(Mandatory)

    Code identifying the type/source of the descriptive number used in Product/Service ID (234).

    Codes (275)
  • SV602234Product/Service ID
    AN
    M必须(Mandatory)
    Min 1 / Max 30

    Identifying number for a product or service.

  • SV6031332Facility Code Qualifier
    ID
    O可选(Optional)

    Code identifying the type of facility referenced

    Codes (2)
  • SV6041331Facility Code
    ID
    O可选(Optional)
    Min 1 / Max 2

    Code identifying the type of facility where services were performed; the first position of the uniform bill type or place of service from health care financing administration claim form or place of treatment from the dental claim form

  • SV605782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 15

    Monetary amount.

  • SV6061328Diagnosis Code Pointer
    N
    O可选(Optional)
    Min 1 / Max 2

    A pointer to the claim diagnosis code in the order of importance to this service

  • SV607380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity.

  • SV6081339Procedure Modifier
    AN
    O可选(Optional)
    Min 2 / Max 2

    This identifies special circumstances related to the performance of the service, as defined by trading partners

  • SV6091328Diagnosis Code Pointer
    N
    O可选(Optional)
    Min 1 / Max 2

    A pointer to the claim diagnosis code in the order of importance to this service

  • SV6101339Procedure Modifier
    AN
    O可选(Optional)
    Min 2 / Max 2

    This identifies special circumstances related to the performance of the service, as defined by trading partners

  • SV6111339Procedure Modifier
    AN
    O可选(Optional)
    Min 2 / Max 2

    This identifies special circumstances related to the performance of the service, as defined by trading partners

  • SV6121073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response.

    Codes (3)